Abstract
Background- The Ross operation offers good autograft function and low re-operation rates for the left ventricular outflow tract, however, the rate of conduit dysfunction in the right ventricular outflow tract (RVOT) remains a significant concern. Percutaneous pulmonary valve implantation (PPVI) is a novel trans-catheter treatment option for RVOT conduit dysfunction. Methods and Results- Of the 156 patients who underwent PPVI at our institutions with the current device, we retrospectively analyzed the outcomes of 11 patients (mean age: 26±5 years) who had RVOT conduit failure, 11.3±3.2 years following the Ross operation. PPVI could be performed in all patients (procedure time: 100±15 min; fluoroscopy time: 20±6 min). The RVOT gradient during catheterization and pulmonary regurgitant fraction (PRF) measured on magnetic resonance imaging (MRI) fell after PPVI (RVOT gradient: 35±6.5 mmHg to 14±2.8 mmHg, P<0.01; PRF: 18±6% to 3±2%, P<0.05). During mean follow-up of 17.4±5.2 months, there was 1 explantation (re-stenosis). The probability for freedom from RVOT re-operation was 100% at 1 year and 85.7% at 3 years. Conclusions- Failure of the conduit in the RVOT following Ross procedure can be successfully treated with PPVI to decrease the cumulative surgical burden in the lifetime management of congenital or acquired lesions of ventricular outflow tracts.
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